2021 Legislative Session Final Report

OR-ACEP 2021 Session Wins Summary

Wins on fair reimbursement, injury prevention and health equity represent wins for emergency physicians and the communities they serve. See page 6 for the full list of priority bills.

• Out-of-network (surprise) balance billing: HB 2042 fails to advance in a big win for emergency physicians. Reimbursement will default to the methodology in the federal “No Surprises Act,” which includes an independent dispute resolution process. OR-ACEP strongly advocated for this outcome. EMTALA requirements and the state ban on balance billing have uniquely disadvantaged emergency medicine. OR-ACEP emergency medicine groups have reported reductions in contracts between 8 percent and 47 percent since March of 2018. This bill will level the playing field in contract negotiations and help to preserve the patient safety net, especially in rural areas.
• Safe storage for guns: OR-ACEP supported SB 554, a landmark bill to keep guns out of the hands of kids and to prevent unintentional injury and death.
• CAWEM coverage for End Stage Renal Disease (ERSD) dialysis patients: Funding in the OHA budget bill will provide life-saving scheduled dialysis treatment for undocumented patients who otherwise must wait until their condition lands them in the ED. This coverage, combined with Cover All People (HB 3352) will help provide access to critical health services for Oregon’s uninsured population.

“Brighter days are ahead.”

– Governor Kate Brown, as the state emerges from the COVID-19 pandemic.

2021 Legislative Session Overview

• Oregon’s first virtual session adjourns as the Governor signs a recovery-focused executive order lifting all remaining COVID-19 health and safety restrictions June 30.
• House Democrats pass key priorities during in exchange for giving up their redistricting advantage.
• Federal dollars and a “stunning” state tax revenue forecast lead to historic investments.

The 81st Legislative Assembly convened on January 21 and adjourned on June 26, one day ahead of the June 27 constitutional deadline. The Capitol building was closed to all but legislators and staff because of the COVID-19 pandemic. All public hearings and committee meetings were held online and public participation was completely virtual. As Oregon nears the 70 percent vaccine threshold, the Governor has announced a lifting of emergency pandemic restrictions June 30. The Capitol building will technically be open to the public on July 12 but most areas of the building will be closed until 2023 because of Capitol construction projects.

Democrats held super majorities in the Senate (18D-11R-1I) and in the House (37 D-22 R-1 vacant) but a Senate Republican walkout and the House Republican caucus practice of requiring all bills be read in their entirety from March 9 until April 14, threatened another impasse similar to those in 2019 and 2020. Walkouts in 2019 led the sacrifice of key policy bills (immunizations, safe storage) in order to pass the $2 billion corporate activities tax to fund education. Walkouts over climate change in 2020 led to the breakdown of session with only three bills passing before adjournment. A deal was cut by House Speaker Tina Kotek, D-NE Portland, and Republican Leader Christine Drazen, R-Canby, to share power on the Redistricting Committee to draw boundaries for political districts for the next 10 years. In exchange, Republicans agreed to stop their slow-down tactics. A special session on redistricting has been scheduled for September 20, 2021.

Key Priorities Pass

Democratic supermajorities allowed them to pass bills that made transformative investments in housing, wildfire recovery, behavioral health, racial equity, clean energy, community investments and more. Federal American Rescue Plan Act (ARPA) dollars and a whopping big state revenue forecast helped to propel Oregon out of the pandemic recession of 2020 towards a prosperous recovery. The funds may have also played a role in preventing last minute walkouts. Each legislator was given ARPA funds — $4 million for the 30 senators, $2.5 million for 60 state representatives — to invest in their communities. The economic forecast will also provide what Mike McMullen, the state economist, called “The mother of all kickers,” expected to send more than $1.4 billion back to taxpayers in a personal kicker. The corporate kicker, which is projected to be $664 million, will be dedicated to K-12 education funding.

Racial Justice and Equity

Racial justice and equity were themes of particular significance this session. Gov. Kate Brown lauded Oregon’s Racial Justice Council, Reimagine Oregon and the Legislative BIPOC Caucus for their work to address Oregon’s history of racism and division. HB 2168 will make Juneteenth an official state holiday and HB 2167 will codify the Racial Justice Council into state law. HB 2929, a police reform bill, requires officers to report misconduct or intervene to stop it.

Lawmaker Conduct

The session was not without moments of high drama that led first with the resignation of state representative Diego Hernandez, D-Portland, then punishment for State Rep. Brad Witt, D-Clatskanie and finally, the historic expulsion of Rep. Mike Nearman, R-Independence.

Rep. Hernandez, facing possible expulsion for violating sexual harassment rules, resigned March 15. He was replaced by Andrea Valderrama, a community organizer. This made women the majority of legislators in the House for the first time. Rep. Witt lost the gavel to chair the House Agricultural and Natural Resources Committee for a violation of workplace sexual harassment rules. Rep. Mike Nearman, who opened the door to allow far-right armed rioters into the Capitol during the Dec. 21 special session on COVID-19, was expelled from the legislature by a vote of 59-1. Nearman was the first person to be expelled in Oregon history after compelling video emerged showing that he helped to coordinate the attack. Nearman also faces charges of official misconduct and criminal trespass in Marion County Court.

2021 Budget

State budget totals at $29.7 billion this biennium, up from $25.6 billion last biennium due to Federal American Rescue Plan Act dollars and a breathtaking revenue forecast. The budget also includes $600 million for recovery from the 2020 wildfire season and a historic $470 million investment in behavioral health. The K-12 budget was funded at $9.3 billion.

Oregon Health Authority Budget (OHA) (HB 5024)

“A significant and extraordinary budget.”

Sen. Kate Leiber, Co-chair, Jt. Ways and Means Committee on Human Services.

“The 81st session will be remembered as the one where we finally started making investments to bring about the promise of the deinstitutionalization of people with mental illness and started making community based treatment an actual reality.”

Rep. Rob Nosse, Co-Chair, Jt. Ways and Means Committee on Human Services

OHA budget includes historic investments in behavioral health. The total package, contained in House Bills 5024, 2086,2949,2417,2316 and 2980 include more than $470 million in allocations.

HB 5024 Big Picture Overview-

• General Fund resources $3.6 billion this biennium up from $2.5 billion last biennium
• Budget total budget represents 66.2 percent increase over legislatively approved budget (LAB) for 2019-21.
• Entire current service level (CSL) is covered and there are no cuts to OHP/Medicaid services.
• Caseload growth accounts for largest cost increase in current service level at an increase of 225,000 OHP members since March 2020.

Key Health Investments:

Health Equity:

• Health Equity Implementation (package 402): $6.9 mil/ $5.5 mil General Fund and 17 new positions to OHA Office of Equity & Inclusion (OEI) to support OHA’s 10-year goal to eliminate health inequities in the state.
• Managed Care Entity for Tribal Members: $1.4 mil to establish and support Indian Managed Care Entities to provide OHP care coordination services.
• Tribal Traditional Health Care Workers: includes funding for the creation of a sixth, separate Traditional Health Worker category corresponding to HB 2088 which has already been approved by the Ways & Means process.
• End Stage Renal Dialysis: $1.1 mil and corresponding matching Medicaid revenue to expand outpatient dialysis coverage to individuals who would be eligible for full Medicaid benefits except for their immigration status.

Behavioral Health:

• Regional Development and Innovation: $130 mil (including $65 ARPA funds) for capital, start-up, and operational costs related to increasing statewide capacity of licensed residential facilities and housing for people with behavioral health needs.
• Transformation and System Alignment: $50 mil for investments that align outcomes, roles, responsibilities, risk and incentives in behavioral health system.
• Certified Community Behavioral Health Clinics (CCBHC): $121 mil to existing CCHCs.

Aid and Assist:

• Funding $21.5 mil for community restoration and clinical services, rental assistance and wraparound support for supporting needs of individuals ordered by a court to receive services enabling them to “aid and assist” in their own criminal defense.
• Oregon State Hospital Capacity: $31 mil toward 110 positions to open two 24-bed units at Junction City campus with separately recommended $20 mil to Emergency Board to be available for supporting OSH staffing levels.

Drug Addiction and Recovery Services:

• Ballot Measure 110 (2020) establishes a new Oversight and Accountability Council to establish new Behavioral Health Resource Networks (BHRNS) to provide addiction and recovery services in every county.

Public Health:

• Modernization of Public Health (package 417): $45 mil to advance public health modernization efforts in areas of communicable disease control, emergency preparedness and response, health equity, and environmental health.
• Universally Offered Home Visiting (package 418): $7.8 mil
• Psilocybin Ballot Measure 109: $2.2 mil to support establishing a new program for the administration of psilocybin services.
• Newborn Metabolic Screening: Spinal muscular atrophy testing (SMA) was added to the newborn screening panel at a cost of $440,000.

Other investments

Funding is also included for SB 1, the System of Care Council (SB 1, 2019) $4.9 million, plus $6.5 million for mobile response and stabilization and $5.7 million for interdisciplinary assessment teams. In addition, there is funding for the Intensive Services Unit of $1.8 million plus, $7.5 million for Psychiatric Residential Treatment Services Capacity $7.5 million, Young Adults in Transition, $9 million.

Note: See end of report for OHA budget notes.

HB 5006 Budget Reconciliation

“The amount of projects around the state is beyond staggering.”

Senate President Peter Courtney

HB 5006 is the budget reconciliation (Christmas Tree) bill of $1.47 billion of American Rescue Program Act appropriations. Oregon’s latest share of relief funding was $2.6 billion. The total spend was $5.5 billion. As part of HB Bill 5006, $240 million in federal American Rescue Plan Act funds were approved for the Department of Administrative Services (DAS) to distribute in each Senate and House district in the amounts of $4 million per Senate district and $2 million per House district, for projects identified in the following table, as long as the identified use is ARPA eligible. Here’s a complete list: https://olis.oregonlegislature.gov/liz/2021R1/Downloads/CommitteeMeetingDocument/246418

Note: Should an item in the table be determined to be ineligible for ARPA funding, DAS will notify the Legislative Fiscal Office which will work with legislative leadership and the Senator or Representative of the affected district to ensure the funds are spent on ARPA eligible items.

 HB 5006 also included the following health and public health investments:

• $10,000,000 lottery funds for disbursement to Multnomah County for Behavioral Health Resource Center
• $20 million behavioral health housing incentive fund (Lottery funds — SB 5534)
• $3,000,000 Other Funds for disbursement to City of Redmond for a Public Safety/Mental Health Triage Center.
• $410 million in bonded debt to the Oregon Housing and Community Services agency to develop over 3,000 units of affordable and supportive housing for people who have experienced chronic homelessness.
• $6 million child abuse centers.
• $750,000 for an emergency response and community services facility in the city of Mosier
• $1.4 million for a children’s psychiatric residential treatment program in Boardman.
• $800,000 for the City of Salem to convert motels or hotels to shelter housing through the Turnkey Project.

Legislator Earmarks (selected)

• $750,000 Nonviolent Crisis Intervention Training for Children’s Residential Facilities staff. (Sen. Sara Gelser, D-Corvallis)
• $750,000 Non-Congregate Sheltering for Chronically Homeless in Salem.  (Sen. Deb. Patterson, D-Salem)
• $2.2 million, Beaverton Homeless Shelter/Mental Health Court (Sen. Kate Lieber, D-Beaverton.)
• $195,000 Reach Out and Read, (Sen. Elizabeth Steiner Hayward, D-Beaverton, NW Portland.)
• $1.2 million Central City Respite Center and Recuperative Care. (Sen. Elizabeth Steiner Hayward, D-Beaverton, NW Portland.)
• $1 million, Downtown/Old Town Respite Center. (Sen. Ginny Burdick, D-Portland.)
• $600,000 South Metro Racial Justice and Equity Program. (Sen. Rob Wagner, D-Lake Oswego.)
• $2.3 million, Multnomah County. (Sen. Michael Dembrow, D-NE Portland.)
• $225,000 Lande County Public Health Equity and Resilience Grants Program (Rep. Julie Fahey, D-Eugene.)
• $173,000, Salem Free Clinics, (Rep. Teresa Alonso-Leon, D-Woodburn.)
• $250,000 A Family’s Place Child Abuse Prevention (A Family Place Relief Nursery Yamhill Co.) (Rep. Ron Noble, R-McMinnville.)
• $100,000 Public Health Outreach Van. (Rep. Courtney Neron, D-)
• $8000 Beaverton YMCA Child Development Center (Rep. Shari Schouten, D-
• $700,000 Central City Concern Clinical Respite Center (Rep. Maxine Dexter, D-NW Portland.)
• $100,000 Central City Concern Peer Respite Center (Rep. Lisa Reynolds, D-SW Portland)
• $100,000 Neighborhood House Food Pantry (Rep. Lisa Reynolds, D-SW Portland)
• $300,000 Partnership for Community Health Care and Education (Rep. Andrea Salinas, D-Lake Oswego)
• $103,000 Canby Fire District COVID response supplies (Rep. Christine Drazan, R-Canby)
• $950,000 Central City Concern Clinical Respite Center (Rep. Rob Nosse, D-SE Portland)
• $800,000 Central City Concern’s Recuperative Care Program (Rep. Barbara Smith Warner)
• $1 million, Gresham-Barlow School Based Health Center Development, (Rep. Ricki Ruiz, D-Gresham)

Note $4.8 million was allocated to Central City Concern in total.

Budget writers will hold $500 million in reserve. This includes $150 million for the state’s wildfire response.

2022 Session Preview

The 2022 Legislative Session will be virtual given the Capitol building construction that won’t be completed until 2023. Legislators will be able to access the chambers of the House and Senate but not their personal offices. The building will be closed to the public and all hearings will be online. Parking will be limited.

The parameters for the short session are similar to past sessions. The deadline for legislators to submit measure requests to Legislative Counsel is November 19, 2021. The 2022 session convenes February 1, 2022. This is a short (turbo!) session so each Senator and Representative may request no more than two drafts of measures. Each interim committee may request no more than three. The Governor is also limited to three drafts as is the Chief Justice of the Supreme Court. This will limit the universe of bills but it’s not likely to limit challenging policy issues. While the original intent was to handle emerging budget items during the 35-day session, legislators frequently opt to battle over climate change or other contentious bills.

Summary of Priority Bills

State agencies already are working to implement bills with emergency clauses. All other bills will take effect January 1, 2022. Many of those bills will require interim participation in stakeholder activities such as rule making and work groups. Here are summaries of priority bills:

OR-ACEP Key Priority Bills

Fair Reimbursement

HB 2042 Out-of-Network Balance Billing

Status: Died in Committee

What the bill does: Removes sunset on reimbursement methodology in statute for out-of-network balance billing. The “No Surprises Act” federal reimbursement methodology with an independent dispute resolution process) will apply to all health plans in Oregon, whether fully-insured or self-insured.

Background: OR-ACEP has been working on a solution for fair reimbursement for out-of-network balance billing since 2016 and was a key player in the negotiations for HB 2339 (2017) and SB 1549 (2018) and the workgroups to develop the reimbursement methodology. Emergency physicians were uniquely disadvantaged. About three percent of all emergency claims are out-of-network, yet insurers used EMTALA requirements and the ban on balance billing as leverage in contract negotiations. Since the ban on balance billing went into effect in March 2018, OR-ACEP emergency medicine groups have reported reductions in contracts between 8 percent and 47 percent.

Position: Strongly opposed original bill without amendments to include a fix for emergency medicine. This policy with no modifications, would have harmed emergency medicine given EMTALA requirements and the ban on balance billing. It enshrines the payer advantage in contract negotiations in law and will eventually jeopardize the patient safety net. It’s also not clear if deductibles for OON emergency care are the same as for in-network care. The chapter strongly advocated for an alignment with the federal “No Surprises Act” and worked closely with DCBS, legislator and other stakeholders to promote this solution.

Interim Action: OR-ACEP President Chris Strear is a member of the ACEP reimbursement committee that is engaged in the federal rule making process to implement the No Surprises Act.

Health Care Administration

HB 2076 Emergency Health Care Systems Program (EMS Regionalization)

Status: Died in committee

What the bill does: This proposal provides for an integrated Emergency Healthcare System that recognizes problems, determines which services needed and then delivers the patient to those resources. Such a system can provide for better coordination of emergency care, regionalization to allow smaller agencies to benefit from economies of scale, improved targeted transport of patients to regional specialty centers, and improved assessment, triage and transfer from small general hospital to regional referral centers.

Background: Oregon does not currently have a comprehensive Emergency Medical Services (EMS) & Trauma system. There is no unifying individual, agency, or plan for the provision of emergency medical services throughout state government, no system for regionalization of emergency medical services to treat time-sensitive emergencies, and no plan that will allow for surge capacity in the event of a medium or large size disaster. This policy concept was originally introduced in 2011 and was based on recommendations from the 2010 Emergency Healthcare Task Force Report, chaired by OR-ACEP board member John Moorhead, MD. Dan Handel, also an OR-ACEP board member, served as co-chair.

CLIENT Position: Support. OAHHS and Fire Chiefs Association opposed this bill, raising concerns about lack of an interim workgroup.

Interim Action: Serve on an OHA task force if convened to develop recommendations for the 2023 Legislative Session.

Opioids

HB 2376 Required Rx for Naloxone

Status: Died in Committee

What the bill does: Requires health care provider who prescribes opioid to offer prescription for naloxone, or similar drug, and educational material under specified circumstances. Requires penalties for non-compliance.

Background: This bill was introduced on behalf of Emergent BioSolutions. As of September 30, 2020, ten states have enacted laws or regulations that require certain medical professions to prescribe or offer a prescription for naloxone to some individuals under their care. Proponents for the bill say this has resulted in a five-fold increase in prescription for Narcan and a study in California found 63 fewer ED visits related to overdose.

CLIENT Position: Opposed to the approach in HB 2376. OR-ACEP strongly supports working with legislators to remove barriers to getting patients access to MAT and to support greater Narcan availability.

Interim Action: Work with Rep. Rachel Prusak, the chair of the House Health Care Committee, on strategies to address the opioid crisis. The biggest barriers include access to Narcan, lower thresholds for prescribing Buprenorphine and treatment for those without insurance. 

Workforce

SB 143/HB 2433 Rural Provider Tax Credit

Status: Passed.

What the bill does: SB 143 extends the  sunset for the tax credit for rural medical care. Amendments to HB 2334 include frontier emergency physicians to the exception to the gross income eligibility cap of $300,000.

Background: The Office of Rural Health estimates there are 38 frontier emergency physicians who would qualify given the new exception. A frontier physician works in a county with 6 or fewer people per square mile — Lake, Harney, Malheur, Baker, Grant, Wallowa, Wheeler, Morrow, Wheeler, Gilliam and Sherman Counties. Eligible hospitals include Lake District Hospital, Harney District Hospital, Blue Mountain Hospital, Pioneer Memorial Hospital, Wallowa Memorial Hospital, Saint Alphonsus Medical Center (Baker City and Ontario.) All other providers are subject to the income eligible cap of $300,000. In order to be eligible for the tax credit, the providers must work 20 hours per week in a rural qualifying area, providing services for Medicare and Medicaid patients.

CLIENT Position: Support. OR-ACEP advocated for an exception for all rural emergency physicians from the income eligibility cap of $300,000. According to the Office of Rural Health there are 258 emergency physicians in rural areas.

Interim Action: The sunset on the tax renewal expires in 6 years. OR-ACEP works with the Rural Health Coalition to advocate for expansion and renewal of this tax credit.

Equity

HB 5024 CAWEM Coverage for End Stage Renal Disease dialysis patients (package 405)

Status: Passed

What the bill (package) does: Package 405 in the OHA budget bill allocates $1.1 million General Fund and corresponding matching Medicaid revenue is included to expand outpatient dialysis coverage to individuals who would be eligible for full Medicaid benefits except for their immigration status.

Background: The lack of coverage for life-saving dialysis treatment means that some undocumented dialysis patients are forced to resort to emergency dialysis in the emergency department when their condition meets a critical and dangerous threshold. This is at odds with the standard of care for people living with end stage renal disease (ESRD) and results in higher mortality rates (3 percent for scheduled dialysis vs. 17 percent for emergency dialysis). The appropriate standard of care should be scheduled dialysis rather than waiting until the life of the patient is threatened.

CLIENT Position: Support. OR-ACEP worked closely with Dr. Rob Rope at OHSU, a champion for this policy.

Interim Action: Promote awareness that CAWEM patients with ESRD will be eligible for scheduled dialysis services.

Injury Prevention

SB 554 Safe storage of guns

Status: Passed

What the bill does: Requires a person who owns or possesses a firearm, while not carried or under the control of the person or an authorized person, to secure the firearm with an engaged trigger or cable lock or be stored in a locked container or a gun room as defined by the measure. Also bans guns in the Capitol and Portland International Airport.

Background: Among U.S. adolescents and young adults 10-24 years old, gun homicides are the third leading cause of death; gun suicides are the second. In 2010, 15,576 children were treated for gun injuries in U.S. emergency departments, and 1,970 of them died. Studies have found that adolescents’ risk for suicide increases as their access to firearms increases. Suicide attempts in children are more likely to be successful when they have access to lethal weapons; 90 percent of suicide attempts with guns are successful, compared to less than 5 percent of suicide attempts using less lethal means, like medications or sharp objects. The risk for unintentional injury and suicide in children is reduced when guns are kept locked.

CLIENT Position: Support.

HB 2836 Traumatic Brain Injury Reporting Requirements

Status: Died in committee

What the bill does: Requires health care provider to include information related to diagnosed or suspected brain injury in patient’s medical chart and other specified records.

Background: Introduced by Rep. Courtney Neron on behalf of the Brain Injury Research and Training program.

CLIENT Position: Opposed bill as introduced. OR-ACEP met with Rep. Neron, David Kracke and Melissa McCart from the Brain Injury Research and Training program and Dr. Jim Chestnut. Their goal is to improve charting for potential brain injuries so there can be continuity of care from the emergency department to other care providers. This will also help some patients to get referral for follow-up care and to have that care reimbursed by their insurer. OR-ACEP noted that putting charting requirements in statute is not an optimal approach and unlikely to standardize the process. A better approach would be to have OHA issue guidelines to standardize the charting and develop educational materials to be distributed to hospitals.

Interim Action: Work with advocates to improve availability of follow-up care for people with traumatic brain injuries.

Liability

Practice Environment

SB 110 Early Discussion and Resolution Program

Status: Passed.

What the bill does: Repeals sunset on early discussion and resolution program for resolving adverse health care incidents.

Background: The Oregon Legislature created the Early Discussion and Resolution program in 2013 and charged the Oregon Patient Safety Commission (OPSC) with its administration. The OPSC connects patients or families to involved healthcare professionals when either requests an EDR conversation. They also provide resources to support patients or families and healthcare professionals to have an open, constructive conversation and reach resolution. 

CLIENT Position: Support.

Interim Action: OR-ACEP Board member John Moorhead, MD, chairs the Task Force on Resolution of Adverse Healthcare Incidents. Board member Saleen Manternach, MD, serves on the task force.

HB 780 Medical liability during COVID-19

Status: Died in Committee

What the bill does: Senate Bill 780 A prohibits some legal actions against health care organizations and health care providers during the COVID-19 state of emergency. In order to receive the immunity, the health care provider must have been providing care so as to comply with the COVID-19 emergency rule in effect at the time of the act or omission. Liability protection is not given to acts taken with gross negligence, reckless, wanton, or intentional misconduct, false claims, fraud, or deceptive acts or practices. Liability protection is also not given to delays or cancellations of elective or nonurgent procedures that create an irreversible risk of harm to the patient.

Background: In response to the COVID-19 pandemic, many health care providers had to alter their normal standard of care for reasons that are outside of their control—including the Governor’s Executive Orders banning non-emergency care. The limited liability protections in SB 780A do not apply to cases of gross negligence or reckless misconduct and are limited to the period of the COVID-19 emergency.

CLIENT Position: Support.

Interim action: Participate in coalition efforts to address liability concerns.

SB 193 Non-economic damages

What the bill does: Removes statutory cap on noneconomic damages for claims for bodily injury. Retains cap on noneconomic damages for wrongful death. Requires jury in a criminal action to render a verdict of guilty only by unanimous agreement and a verdict of not guilty only by a concurrence of at least 10 of 12 jurors.

Background: The Oregon Supreme Court found in Busch v. McInnis Waste Systems, Inc., 366 Or. 628 (2020) that the cap on the amount of noneconomic damages that could be awarded to an injured party in a bodily injury case deprived the party of their right to a remedy under Article 1, Section 10 of the Oregon Constitution. Opponents to the bill contend that although the Supreme Court decision in Busch invalidated the non-economic damages cap as

applied to the claim in that case, no court has held that the cap is invalid in every cause of action except for wrongful death.

CLIENT Position: Oppose. Providers and insurers opposed the repeal of the cap on non-economic damages. See floor letter.

Interim Action: Physician legislators may convene an interim workgroup on liability. OR-ACEP will participate in coalition efforts to provide a fair practice environment.

Behavioral Health Budget Packages

The Legislature approved a “monumental” $470 million behavioral health package. It is contained in House Bills 5024, 2086, 2949, 2417, 2316, and 2980, and included the following investments in Oregon’s behavioral health system:

• $130 million to increase statewide capacity of licensed residential facilities and housing for people with behavioral health needs.

• $121 million to support Certified Community Behavioral Health Clinics (CCBHCs). CCBHCs operate 24/7 to provide mental health and substance abuse disorder treatment, regardless of an individual’s ability to pay.

• $80 million to create two incentive programs to increase the capacity and diversity of Oregon’s behavioral health workforce.

• $50 million to transform Oregon’s behavioral health system by aligning expected outcomes, roles, responsibilities, and incentives with funding.

• $31 million to open two 24-bed patient units and fund 110 staffing positions at the Oregon State Hospital Junction City campus.

• $20 million for a Behavioral Health Housing Incentive Fund.

• $10 million to fund mobile crisis intervention teams.

• $9.2 million for Young Adult Transitional Housing.

• $6.5 million for mobile crisis response and stabilization services for children.

• $6 million will fund four peer respite centers to provide services to individuals experiencing a behavioral health crisis. A center will be set up in each of the four regions: the Portland metropolitan area, Southern Oregon, Central and Eastern Oregon, and the Oregon Coast.

• $5.7 million to support interdisciplinary assessment team services for youth with intensive behavioral health needs.

• $5 million to fund a 9-8-8 crisis hotline center.

In addition to the behavioral health care package, the Legislature approved other investments to support behavioral health services in Oregon:

• $302 million to implement Ballot Measure 110 (2020) which will fund Behavioral Health Resource Networks throughout the state.

• $21.5 million for counties to provide community-based restoration services for individuals unable to aid and assist in their own defense at trial (“Aid and Assist” patients).

• $1.5 million for tribal-based behavioral health practices.

• $7.5 million to add 47 Psychiatric Residential Treatment Services beds for children and adolescents.

Status of Major Health Legislation

These reports were compiled using sources which include the staff measure summary, stakeholder testimony, coalition fact sheets, fiscal impact statements and other information from program experts. Click on links to read staff measure summary for policy bills or legislative fiscal office/ subcommittee recommendation for budget bills.

Fair Reimbursement and Access to Care

PASSED

HB 2508 Telehealth Pay Parity

This bill expands access for telehealth by requiring pay parity on par with the reimbursement for an in-person visit.

SB 164 Modifies provisions of corporate activity tax.

Amendments to exclude Medicaid and Medicare receipts for the purposes of the CAT Tax failed, but a provider coalition will take up the issue at a future session.

FAILED

HB 2042 “Surprise Billing” Out-of-Network Balance Billing.

In a big win for emergency medicine, failure of this bill means that reimbursement methodology for out-of-network emergency claims, will default to the Federal “No Surprises Act” methodology which includes an independent dispute resolution process.

HB 3108 Access to Primary and Behavioral Health Care

Requires reimbursement of three primary care visits without cost-sharing, no double mental health and health care co-pays on the same day.

Health Equity

PASSED

HB 2086 Governor’s Racial Ethnic Justice Council investments

Appropriates $10.6 million to increase reimbursement rates for co-occuring disorder treatment.  $400,000 will be dedicated to collect data from providers who offer intensive behavioral treatment services.

HB 3352 Cover all People.

Renames Health Care for All Oregon Children program as Cover All People program and expands eligibility to adults who would qualify for Medicaid-funded state medical assistance program but for their immigration status. Appropriates $100 million General Fund to pay for coverage for the 6 percent of Oregonians who are uninsured. The program begins July 2022.

HB 2359 Health care interpreter registry

Requires health care providers to work with health care interpreters from health care interpreter registry operated by Oregon Health Authority to provide interpretation services.

HB 2949 Expands capacity and diversity of behavioral health workforce

American Rescue Program Act provides one-time funding of $80 million.

HB 3159 REALD and SOGI data collection.

Requires coordinated care organization, health care provider or health insurer to collect from patient, client or member data on race, ethnicity, preferred spoken and written languages, disability status, sexual orientation and gender identity. The information will be used to address health disparities. Appropriates $9.8 million General Fund, $5.6 million Other Funds and $2.8 million Federal Funds for initial program costs. 43 FTE.

HB 3265 Prohibits prohibits state law enforcement only from assisting with or supporting the enforcement of immigration law

Appropriates $905,071 General Fund to the Department of Justice (DOJ) Office of the Attorney General, Civil Rights Unit, to create a staffed sanctuary violation hotline and website.

HB 3353 Use of CCO global budgets for health equity

Requires OHA to seek federal approval of state Medicaid demonstration project to allow CCOs to use portion of global budgets to promote equity or enhance payments to providers to do so.

SB 567 Health care discrimination

Includes as unlawful practice medical provider’s denial of treatment that is likely to benefit patient based on patient’s race, color, national origin, sex, sexual orientation, gender identity, age or disability.

HR 6 Declares Racism is a Public Health Crisis

This resolution replaces HB 2337 as the vehicle to declare racism a public health crisis.

SB 428 Extends Task Force on Universal Health Care

$516,768 General Fund is appropriated to hire analysts and consultants to support the task force, project management and policy research and analysis.

SB 572 Protective proceedings to permit vulnerable youth guardianships for youth between 18-21 with special immigration status.

SCR 17 Establishes environmental justice framework of principles for State of Oregon

SJR 12 Health Care is a Human Right. Referral to 2022 ballot.

The late Rep. Mitch Greenlick, D-NW Portland, originally introduced as the HOPE Resolution.

FAILED

SJM 1 Urges Congress to enact legislation implementing internal Immigration and Customs Enforcement policy prohibiting enforcement actions in sensitive locations.

HB 2337 Racism as a Public Health Crisis

HJR 6 is the new vehicle for this policy. Action strategies in HB 2337, which include REALD and data collection, community involvement in legislative process, Racial Justice Council, health care interpreters, payments for people serving on boards and commissions, are contained in other bills.

Health Care Workforce

PASSED

HB 2433 Rural Provider Tax Credit Provisions (Replaces SB 143)

Extends sunset on rural provider tax credit. Frontier emergency physicians are now exempt from the gross income eligibility cap of $300,000.

HB 2949 Expands capacity and diversity of behavioral health workforce

Requires Oregon Health Authority to provide incentives to increase recruitment and retention of mental health workforce, including pipeline development, scholarships for undergraduates and stipends for graduate students, loan repayments and retention activities. $80 million.

HB 3036 Physician assistant practice agreements and collaboration.

Defines “collaboration,” and “collaboration agreement” between a physician assistant (PA) and physician, including requiring the agreement be signed by PA and physician or PA’s employer. Replaces current requirements for supervising physicians or physician organization to receive Oregon Medical Board (OMB) approval to use services of a PA, with collaboration agreement requirements.

Opioids/Pharmaceutical Regulation

PASSED

HB 2646 Kratom regulation

Establishes regulations for kratom products, including testing standards, labeling requirements and minimum age for sale.

HB 3045 Mental health drugs/prior authorization

Changes the sunset date requiring the Oregon Health Authority to reimburse the cost of a mental health drug prescribed to medical assistance recipients from January of 2022 to 2026. The measure prohibits OHA from requiring prior authorization for any mental health drug prescribed for a medical assistance recipient if recipient has been in a course of treatment with the drug during the preceding year.

HB 2648 Pseudoephedrine at pharmacies

Allows pharmacies to dispense pseudoephedrine to adults with government-issued identification.

SB 844 Prescription Drug Affordability Board

Establishes program in DCBS and assesses fees to pharmaceutical manufactures to pay for costs of implementing the bill.

FAILED

HB 2376 Requires health care providers to offer Rx for naloxone under specified circumstances.

Public Health

PASSED

HB 2261 Prohibits online sale of vaping products

SB 554 Safe storage of guns

This landmark bill helps keep guns out of the hands of kids and to prevent firearm injury and death.

SB 587 Tobacco retail licensure

The Department of Revenue regulates the sale of tobacco and requires OHA and local county health departments to enforce the law.

HB 2021 Greenhouse gas emission reduction requirements

Requires retail electricity providers to reduce greenhouse gas emissions associated with electricity sold to Oregon consumers to 80 percent below baseline emissions levels by 2030, 90 percent below baseline emissions levels by 2035 and 100 percent below baseline emissions levels by 2040. Appropriates $50 million General Fund.

HB 2077 Lead-based paint program

Grants OHA additional authority to require clean-up of lead-based paint hazards.

HB 5024 Public Health Modernization

The OHA budget bill appropriates $45 million General Fund.

SCR 3 In memoriam: Representative Mitch Greenlick 1935-2020.

Healthcare and Systems Administration

PASSED

HB 2010 Public option implementation plan

Requires OHA to create implementation plan for public health plan to be made available to individuals and families in individual health insurance market and to small employers.

HB 2074 Increases prescription drug monitoring fees from $25 to $35

HB 2081 Health Care Cost Growth Target Program modifications and implementation.

Requires OHA to collaborate with payers and providers on performance improvement plans and specifies required elements of plan to achieve the cost growth target. Prohibits penalties prior to 2026 for performance during calendar years 2021-2025.

HB 2517 OHA utilization management streamlining bill

Requires Oregon Health Authority to compile and annually post to website report on information reported to authority by coordinated care organizations regarding requests for prior authorization. Modifies utilization management protocols among insurers, providers, and enrollees including the use of prior authorization and step therapy.

HB 2362 Mergers and Acquisitions

Requires OHA review of mergers and acquisitions over $25 million in revenue. Commissions study on health care consolidation. Exemptions include medical service contracts and affiliations among entities that do not affect governance or control or are required to advance value-based contracts.

HB 3159 REALD and SOGI data collection.

Requires coordinated care organization, health care provider or health insurer to collect from patient, client or member data on race, ethnicity, preferred spoken and written languages, disability status, sexual orientation and gender identity. The information will be used to address health disparities. Appropriates $9.8 million General Fund, $5.6 million Other Funds and $2.8 million Federal Funds for initial program costs. 43 FTE.

SB 428 Extends Task Force on Universal Health Care

$516,768 General Fund is appropriated to hire analysts and consultants to support the task force, project management and policy research and analysis.

SB 844 Prescription Drug Affordability Board

Establishes 5-member Prescription Drug Affordability Board in Department of Consumer and Business Services to review prices and affordability of prescription drug products sold in Oregon.

FAILED

HB 2076 Emergency Health Care Systems Reform

Provides for a regional, integrated Emergency Healthcare System that recognizes problems, determines which services needed and then delivers the patient to those resources.

Practice Environment

PASSED

SB 110 Repeals sunset on early discussion and resolution program for resolving adverse health care incidents.

SB 193 Removes statutory cap on noneconomic damages for claims for bodily injury.

Retains cap on noneconomic damages for wrongful death.

SB 199 Advance directives

Revises Advance Directive Form. Includes section on values and directions regarding quality of life, spiritual beliefs, life and values, place of care, and other information for health care representative or health care provider. Provides direction to health care representative on discussion of health status with others.

SB 567 Prohibits discrimination in healthcare.

Defines terms and prohibits licensed or certified health care providers or individuals acting on behalf of a provider from denying, limiting, or restricting a medical service based on a patient’s race, color, national origin, sex, sexual orientation, gender identity, age, or disability. SB 567

FAILED

HB 2836 TBI reporting requirements.

Medical charting requirements for health care providers related to diagnosed or suspected brain injury.

HB 3161 Expanded penalties for violence against health care workers.

SB 780 Medical liability during COVID-19 emergency.

Behavioral Health

HB 2315 Continuing education requirements for behavioral health professionals

HB 2316 Behavioral Health Housing Fund

Establishes an incentive fund and transfers interest earned by the Housing for Mental Health Fund.

HB 3046 Behavioral health parity

Enforces existing behavioral health parity laws and requires annual report to the Legislature in 2025. Specifies behavioral health treatment that must be provided by coordinated care organizations and covered by group health insurance and individual health plans and restricts utilization review criteria for behavioral health treatment.

HB 3139 Notification requirements when a minor is at imminent and serious risk of suicide

SB 187 Decriminalize mental illness

Defines “dangerous to self or others” for purposes of civil commitment as likely to inflict serious physical harm upon self or others within the next 30 days. Allows court to consider past behavior that resulted in physical harm to self or others and threats and attempts to commit suicide or inflict serious physical harm on others.

HB 2086 Governor’s Behavioral Health omnibus bill

Appropriates $10.6 million to increase reimbursement rates for co-occuring disorder treatment.  $400,000 will be dedicated to collect data from providers who offer intensive behavioral treatment services. The bill also amends state law with respect to culturally specific and responsive behavioral health services, treatment and program capacity data, and quality metrics for behavioral health services.

HB 2333 Reporting of psychotropic medications for children in foster care

Directs the Department of Human Services (DHS) to report quarterly to the Legislative Assembly as specified, regarding use of psychotropic medications for children in foster care starting April 1, 2022.

HB 2417 Grants for community mental health program mobile crisis intervention teams

Also includes provisions for the 988 system (911 of behavioral health). Appropriates $15 million, $5 for the crisis hotline and $10 for mobile crisis teams.

HB 2469 Requires OHA to provide mental health wellness appointments for OHP clients

HB 2949 Expands capacity and diversity of behavioral health workforce

Allocates $60 million for incentive programs and $20 million for a new grant program to specific health provisions to provide supervised clinical experience to associates or other individuals in order for them to obtain license to practice in their fields.

HB 2980 Funding for peer-run organizations

Directs the Oregon Health Authority (OHA) to provide funding to one or more peer-run organizations to operate four peer respite centers in the Portland metro area, southern Oregon, the Oregon coast, and central/eastern Oregon. The fiscal impact is $6 million.

HB 3037 Suicide Reporting

Directs medical examiner to report deaths of decedents 24 years of age or younger to local mental health authority if medical examiner reasonably believes manner of death was suicide.

HB 3045 Extends sunset on OHA reimbursement for cost of mental health drugs for OHP.

SB 4 System of Care Advisory Council

Authority to hire an executive director.

SB 72 Modifies circumstances where provider may disregard a person’s wishes regarding mental health treatment to include when the person is extremely dangerous and committed to OHA.

SB 200 County policies concerning guilty except for insanity dispositions.

SB 205 Authorizes court to commit person to state hospital or secure mental health facility during pendency of petition to commit person as extremely dangerous person with mental illness.

SB 206 Modifies procedures when court orders conditional release of person found guilty except for insanity.

SB 295 Defines terms related to fitness to proceed

SB 563 Suicide prevention programs to include children 5-10 years of age.

SB 566 Removes the term “mentally defective from statutes defining sexual offenses.

SB 704 Discrimination as a legal defense

Provides that discovery of victim’s actual or perceived gender, gender identity, gender expression or sexual orientation does not constitute reasonable explanation for extreme emotional disturbance for purposes of affirmative defense to murder in the second degree.

SB 710 Child restraints in certain programs

FAILED

SB 274 Modifies certain provisions of law relating to crime of prostitution to exclude child victims of sex trafficking.

SB 579 Oregon Public Guardian Program for defendants who are unable to aid and assist in their defense and who will be released into the community.

Children’s Health

HB 2261 Prohibits remote sales of vaping products

HB 2826/HB 5006 Grants for children’s advocacy centers.

Funding ($6 million) was included in HB 5006, the budget reconciliation bill.

HB 3379 Prohibits sale of crib bumper pads

Institutes a statewide ban on crib bumper pads within Oregon. This bill was introduced by Rep. Schouten at the request of Ben Hoffman for OHSU.

SB 236 Directs Early Learning Division study on suspension and expulsion in early childhood.

Gradually prohibits childcare and pre-K providers from suspending or expelling children from their centers or programs, while providing providers and parents with the training and support to find alternatives

SB 358 Delays sunset of required health insurance reimbursement for applied behavior analysis for autism spectrum disorder.

HB 2536 Free lunches and breakfasts for school children

SB 720/HB 5006 Family Preservation Project

$620,000 in funding included in HB 5006, the budget reconciliation bill. Directs the Oregon Criminal Justice Commission (CJC), in collaboration with the Department of Corrections (DOC) to establish the Family Preservation Project pilot program at Coffee Creek Correctional Facility (Coffee Creek). Requires the program be administered by the YWCA of Greater Portland (YWCA). Sets goals for the program, which include reducing recidivism and reducing the trauma experienced by children of incarcerated parents.

HB 2544 DHS grants to organizations that provide services to homeless youth.

Includes $3.6 million in grants for community organizations providing services to unaccompanied and unhoused youth.

HB 2077 Lead-Based Paint

Adds statutory authority for OHA to compel cleanup of a lead-contaminated site.

HB 3037 Directs medical examiner to report deaths by suicide to local mental health authority.

SB 5513 Education Budget. Restores $75,000 cut in the Grant in Aid budget for Reach Out and Read (ROR).

Note:  Sen. Elizabeth Steiner Hayward also allocates $195,000 for ROR in her ARPA earmark.

Immunizations and COVID-19

PASSED

HB 3057 Authorizes OHA to disclose individually identifiable information related to COVID-19 to certain person under certain circumstances.

FAILED

SB 254 Removes non-medical exemption for required school-entry immunizations

HB 3030 Allows licensed optometrist to prescribe and administer vaccines and epinephrine and diphenhydramine injections.

Session Recap Media:

Portland Tribune: Oregon lawmakers end session after ok for record spending.

OPB: Oregon lawmakers conclude 2021 session in a crush of bills.

Oregonian: Oregon Legislature concludes session marked by huge spending, racial justice reforms.

OHA Budget Notes

Regional Development and Innovation
The Oregon Health Authority (OHA) shall award up to $5 million to community mental health programs, tribes, Regional Health Equity Coalitions, and other community grantees by September 1, 2021 for identifying community needs, assessing the feasibility and sustainability of potential projects, and other planning activities necessary to increase residential facility and housing capacity with a focus on reducing health inequities. OHA, in consultation with Oregon Housing and Community Services and OHA’s advisory councils, including, but not limited to, the Oversight and Accountability Council, the Oregon Consumer Advisory Council and the System of Care Advisory Council, shall issue a Request for Proposals by December 31, 2021 and a recommendation for how to invest available funds for increasing culturally and linguistically appropriate residential treatment and housing capacity to the legislature by March 1, 2022.

Transformation and System Alignment
The Oregon Health Authority (OHA) shall contract with a third-party evaluator to evaluate current behavioral health programs with respect to budget, staffing, data and metrics analysis and tracking, and contracts. The evaluator shall submit a roadmap to increasing financial transparency, accountability and ongoing reporting on Oregon’s behavioral health needs and outcomes.

Certified Community Behavioral Health Clinics
The Oregon Health Authority (OHA) shall administer the certified community behavioral health clinic (CCBHC) demonstration program and evaluate whether CCBHCs: 1) increase access to behavioral health treatment for residents of this state; 2) provide integrated physical and behavioral health care; 3) offer services that result in improved health outcomes, lower overall health care costs and improved overall community health; and 4) reduce the cost of care for coordinated care organization members. No later than February 1, 2023, OHA shall report its findings to the interim committees and subcommittees of the Legislative Assembly related to health and mental health and to the interim subcommittee of the Joint Committee on Ways and Means with authority over human services agencies’ budgets.

Aid and Assist Services
The Oregon Health Authority shall report to the Department of Administrative Services Chief Financial Office and Legislative Fiscal Office on February 1, 2022 and February 1, 2023 on the number of aid and assist clients served at the Oregon State Hospital and through community restoration, amount of funding awarded to communities and providers, and actual expenditures by community mental health program or direct contracts from the funding available in the agency’s budget for community restoration services, case rate payments, and housing and wraparound services. The reported dollar amounts shall be detailed according to specific service. For amounts expended or obligated on housing and rental assistance, the report shall identify the number of individuals placed in housing as a result of the investments.

CCO Contracts
The Oregon Health Authority shall report to the Legislature on its plans for the next round of coordinated care organization contracting. The report shall include: 1) anticipated milestones and deadline dates; 2) an outline of how the process will provide public transparency and communication; and 3) the anticipated resources the agency will need to perform the next round of CCO contracting. The report shall be delivered to the Joint Committee on Ways and Means by January 1, 2023.

State Hospital Staffing – Special Purpose Appropriation
The Oregon Health Authority (OHA) shall consult with relevant stakeholders to resolve staffing shortfalls at the Oregon State Hospital. The relevant stakeholders OHA shall consult with include, but are not limited to, managerial and direct care staff employed by the Oregon State Hospital; community mental health programs; and hospital and other health care providers. No later than November 1, 2021, OHA shall submit a financially and programmatically sustainable plan to the Emergency Board or Interim Joint Committee on Ways and Means that provides solutions for maintaining appropriate daily staffing levels to ensure the safety of both patients and staff.

Appropriation Structure

The Oregon Health Authority shall work with the Department of Administrative Services Chief Financial Office and Legislative Fiscal Office to establish a more detailed agency appropriation structure for its primary biennial budget bill. At a minimum, this structure shall detail the amount of funding budgeted for Medicaid, non-Medicaid behavioral health, the Public Health Division, Health Policy and Analytics Division, Oregon State Hospital, the Public Employees’ Benefit Board, Oregon Educators Benefit Board, and central administrative functions. This new budget structure shall be recommended and prepared prior to the 2023 legislative session.

For more information about these bill or any other legislative issues, please contact Katy King Government Relations and Public Affairs at KatyKing01@gmail.com or (503) 274-9518